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Wednesday, March 4, 2009

Moves to restrict researchers' access to patient record data will undermine patient care, say top researchers in an article published by the medical journal Pulse. Heads of some of the UK's top research organizations warn that over-protectiveness over the safety of public data will result in UK patients not having access to clinical trials treatments.

The UK government has dropped a key pledge to grant researchers the right in the NHS constitution to access identifiable medical records without needing to get patient consent - this was after an uproar among General Practitioners (GPs).

In order to select clinical trial participants, the researchers say it is essential to be able to access patient data without having to seek consent first. The researchers suggest safe havens be set up so they might access anonymous patient data.

Sir Mark Walport, director of the Wellcome Trust - said the NHS Constitution was "going in the right direction" but Government was dithering over allowing access to anonymous patient data. "It is becoming harder and harder to do research that was previously easy to do. If you actually explain to patients about how their data is going to be used, then they are happy for it to be used."

Sir Mark says the argument is being distorted by concern over high profile data leaks from government agencies "None of these were related to medical research - not one," he said.

Professor Peter Weissberg, Medical Director, British Heart Foundation, said patients could gain access to "gold standard" treatment in clinical trials, but this was being jeopardized by Government moves to curb access to medical records.

Weissberg added "We run the risk of unpicking everything that we have done before, and we may not be able to do landmark studies such as the Heart Protection Study in this country."

Mesothelioma is a form of lung cancer that is almost always caused by asbestos exposure and is most commonly found in the outer lining of the lungs called the mesothelium. A majority of the people who develop mesothelioma contract this cancer through breathing in asbestos fibers or being exposed to asbestos dust while on the job. In cases where mesothelioma is found in a person with no previous occupational exposure, it is summarized that the exposure may have stemmed from asbestos fibers found on the clothes of someone in their home who worked in an area where asbestos dust was found.

There are a number of reasons that make diagnosing mesothelioma in its early stages extremely difficult. The symptoms of mesothelioma can have a latency period of anywhere between 20 to 50 years after the initial asbestos contact, which means by the time the symptoms begin to show, the cancer is already within its advanced stages. Once symptoms are present, diagnosis is still not a speedy process. There are a number of diseases that mirror the symptoms that are found in mesothelioma patients and because of this mesothelioma is often the last stop - usually without prior mention from the patient about the possibility of previous asbestos exposure.

The success of treatment for mesothelioma is dependent on the stage in which the cancer is found. As it is found that most mesothelioma is not discovered until the advanced stages, mesothelioma treatment is often referred to as "unsuccessful." Studies show that when found within either stage I or II, treatment for mesothelioma - usually with a combination of radiation and chemotherapy - is successful in extending the patient's life for five years at a rate of 74.6% (Wikipedia). There are also alternative forms of therapy that can be used in conjunction with conventional treatments, that have been shown on occasion to decrease the size of mesothelioma found in a patient.

Asbestos was used for many years in a wide array of household and industrial products because of its multiple types and uses. It is fireproof, and can also be used as an insulator, thus allowing it to become very popular during the Industrial Revolution. It is unknown whether or not people were aware of the dangers of asbestos fibers at that time, but by the 1900's the risk of asbestos was becoming more obvious. People who lived in mining towns would develop lung problems, and general studies showed that asbestos workers died at a young age. Asbestos, in an undisturbed state, seems to pose no threat. However, as soon as it becomes damaged or friable, the fibers are able to be ingested, thus potentially leading to these or other health problems. Although some companies were aware of this danger, they continued to work with products containing asbestos with no regard to their employees. These blatant injustices are the reason for the popularity of mesothelioma in the field of litigation.

A new study in this week´s PLoS Medicine, reports that the risk of suicide increases two to three time on young men 24 years old or less who leave the UK Armed Forces than those remaining in active service or those in the general population.

In the first two years after discharge, the risk seems to increase in the men with short length of service, and those of inferior rank. Just 14 percent of 20 years old or less and 20 percent of 24 years old or under, had communication with mental health specialists in the year prior to their death, according to the study.

Nav Kapur, Center for Suicide Prevention, University of Manchester, UK, and his team, conducted a cohort study, using data from the National Confidential Inquiry into Suicide and Homicide in connection to all the people who left the UK Armed Forces between 1996 and 2005. The Inquiry, since 1996, has been gathering data on all the suicides in the UK, as well as whether the deceased had contact with mental health services in the year prior to death. Of the 233,803 individuals who left the Armed Forces, 224 committed suicide, during the study period.

The overall suicide rate of the ex-military personnel was comparable to that of the general population, according to the study. Although the absolute risk of suicide is small (in 16 to 19 years old, the rate of suicide was of 29.9 per 100,000 persons and in 20 to 24 years old, 34.0 per 100,000 persons), the rate was higher for younger men.

The cause for the higher risk in young men was not established in the study but researchers point out three key potential elements: -Anxiety due to transition to civilian life -Experience of difficult circumstances while in the military -Vulnerability to suicide prior to enrolling in the military According to the study, there is some proof to confirm the third possibility, since inexpert recruits leaving the military after short lengths of service were at highest risk of suicide. The increased risk may reveal a pre-military weakness.

Kapur and his team suggest suicide prevention strategies should be targeted to young people leaving the military. They say these might incorporate "practical and psychological preparation for discharge and encouraging appropriate help-seeking behavior once individuals have left the services".

Jitender Sareen and Shay-Lee Belik, University of Manitoba, Winipeg Canada, who are both unrelated to the study, underline in an expert commentary, the example of the US Air Force which has a suicide program for the exposed military population. They also reflect on suicide prevention in general public health.